Bridge Street Surgery

Updated 27 February 2017

Bridge Street Surgery is located in Downham Market, Norfolk. The practice is run by six GP partners (four male and two female). The practice employs one female salaried GP, two female practice nurses, three female treatment room nurses and two female health care assistants. The clinical team is supported by a practice manager, a dispensary manager, a team of administrative, secretarial and reception, cleaning and dispensing staff. The practice is a dispensing practice and dispenses to approximately 42% of its patient population.

According to Public Health England information, the practice age profile has higher percentages of patients over 60 years compared to the practice average across England. It has lower percentages of patients aged 0 to 50 years. There are a high proportion of patients with chronic diseases on the practice register.

The practice is open between 8.15am and 6pm Monday to Friday. Telephone lines are open from 8am to 6pm. Extended hours appointments are offered with GPs from 7.30 to 8am Monday and 6pm to 7.45pm Wednesdays. In addition to pre-bookable appointments that can be booked up to seven weeks in advance, urgent appointments are also available for people that need them.

The building provides good access with accessible toilets and car parking facilities are available a short walk from the practice. The practice provides treatment and consultation rooms on the ground floor with lift access to the nurses’ treatment rooms on the first floor.

The practice holds a General Medical Service (GMS) contract to provide GP services to approximately 8,667 registered patients, which is commissioned by NHS England. A GMS contract is a nationally negotiated contract to provide care to patients. In addition, the practice also offers a range of enhanced services commissioned by their local CCG: facilitating timely diagnosis and support for people with dementia and extended hours access.

Out-of-hours care is provided by Integrated Care 24 (IC24) through the NHS 111 service.

Updated 27 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridge Street Surgery on 3 November 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had organised annual health road shows for two consecutive years. These were held in the local Town Hall providing easy access. Multiple charities were invited to provide stalls offering information and advice to patients and clinicians alike. The PPG attended these running a refreshment stall with the aim to raise funds for patient improvement at the practice. In 2016 the practice held a small flu clinic during the road show to further encourage flu vaccine uptake. This was supported by the attendance of nursing and reception staff.

The areas where the provider should make improvement are:

• Ensure patients waiting for their appointments in all areas of the practice can be clearly seen by reception staff to ensure patients whose health might deteriorate can be seen by staff.
• Ensure the process for security of dispensary keys is reviewed and monitored.
• Improve the recording of references for new members of staff and ensure that staff are risk assessed prior to undertaking chaperone duties.
• Continue to develop methods used to proactively identify carers.
• Ensure that the learning from complaints and significant events is shared and disseminated with the appropriate staff within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 February 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that the performance for diabetes related indicators was better than the local and national averages with the practice achieving 99%; this was one percentage point above the local average and three percentage points above national averages. The rate of exception reporting was above the local and national averages, with the practice percentage of 15% across all indicators; this was four percentage points above local averages and five percentage points above national averages.
• Longer appointments and home visits were available when needed.
• Patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice had administered flu vaccinations to 4.3% of patients on the practice at risk register during the 2015 to 2016 flu vaccination clinics.

Updated 27 February 2017

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Childhood immunisation rates for the vaccinations given were high when compared to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 69% to 99% which was above the CCG average of 64% to 96% and five year olds from 75% to 99% which is above the local average of 69% to 95%.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 78%, which was above the CCG average of 84% and the national average of 82%. There was a policy to offer written and telephone reminders for patients who did not attend for their cervical screening test.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 27 February 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above local and national averages.
• The practice looked after patients living in local nursing homes. GPs undertook regular visits and visited patients as and when required.
• The practice had administered flu vaccinations to 20% of patients aged over 65 years old during the 2015 to 2016 flu vaccination clinics.

Updated 27 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The bowel cancer screening rate for the past 30 months was 62% of the target population, which was above the CCG average of 60% and above the national average of 58%.The breast cancer screening rate for the past 36 months was 81% of the target population, which was also above the CCG average of 71% and the national average of 72%.
• Patients had access to appropriate health assessments and checks. These included health checks for new patients and NHS health checks for patients aged 40–74. The practice reported an uptake for NHS health checks for the year 2015/2016 had been 153 completed health checks. Of the 1,458 patients on the practice over 75 years register 1,398 had received an annual health check in the previous 12 months. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.

Updated 27 February 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were generally higher than the clinical commissioning group (CCG) and national averages.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2015 to 31/03/2016) was 92%; this was above the CCG and the national average of 84%. The practice referred patients to various support services as required with a 15% exception reporting rate which was one percentage points above the CCG average and three percentage point above the national average.
• The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 82% this was below the CCG average of 91% and above the national average of 88%. Of the 30 patients identified as experiencing poor mental health on the practice register, 27 has received a health check in the past twelve months with appointments scheduled for the remaining patients.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 27 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice had identified 42 patients with a learning disability on the practice register. Twenty-seven of these patients had received a health check, 13 had been seen for other reviews with invitations sent to the remaining two patients.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.